PREP U: Chapter 38-Agents to Control Blood Glucose Levels

A nurse is providing client education to a 13 year old girl who was just diagnosed with type 1 diabetes. Which statement by the client will alert the nurse that special instructions regarding insulin are necessary?

"I am on the middle school track team." Because the client is on the track team, she will have increased exercise at various times that will require insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising.

A client newly diagnosed with type 2 diabetes has attended educational sessions to provide insight into the diagnosis. Which of the client's statements should prompt the nurse to provide further teaching?

"I'm disappointed , but I take some solace in the fact that I won't ever have to have insulin injections."

The client is scheduled to get a breakfast that at 0700. At what time should the client receive a prescribed dose of insulin lispro?

06:45. With short acting insulins like Lispro , aspart, or glulisine, it is important to inject the medication about 15 minutes before eating.

A nurse is preparing a syringe that contains regular and NPH insulin. To ensure effectiveness, the nurse would administer the insulins within which time frame?

15 minutes.

A patient is taking chlorpropamide. The nurse warns the patient about the possibility of hypoglycemia within approximately which time frame after taking the dose?

3-4 hours.

A client receives a dose of insulin lispro at 8am. The nurse would be alert for signs and symptoms of hypoglycemia at what time?

Between 8:30 and 9:30. Peak effects are 30-90 mins.

A nurse caring for a 48 year old woman who has been hospitalized after injecting the wrong type of insulin. Which sign of hypoglycemia will the nurse be careful to observe for?

Blurred vision.

A nurse is caring for a client with elevated blood glucose levels who is to receive alpha glucosidase inhibitor drug therapy. The nurse understands that this therapy would be contraindicated if the client had what condition? select all that apply

Cirrhosis, chronic intestinal disease, colonic ulceration

Insulin binds with and activates receptors on cell membranes. Once insulin-receptor binding occurs, the membranes become highly permeable to glucose. Which action does this enable?

Entry of glucose into the cells.

The nurse is providing education to a client who has been prescribed therapy with with an antiadiabetic medication. During teaching, the nurse will caution the client against heavy intake of which herb?

Garlic. Garlic has been known to increase hypoglycemia when taken with anti diabetic medications.

A nurse is caring for a patient who has developed a hypoglycemic reaction. Which intervention should the nurse perform if swallowing and gag reflex are present in the patient?

Give oral fluids or candy.

A man is brought to the emergency department. He is nonresponsive, and his blood glucose level is 32 mg/dL. Which would the nurse expect to be ordered?

Glucagon. The client is significantly Hypoglycemic and needs emergency treatment. Glucagon would be the agent of choice to raise the client's glucose level because it can be given intravenously and has an approximate onset of 1 minute.

When reviewing the medication list of a client being seen in the clinic, the nurse notes that the client is receiving glipizide . Based on the nurse's understanding, this drug is used to treat?

Hyperglycemia

When describing the effects of incretins on blood glucose control to a group of students, which would an instructor include?

Increases insulin release. Incretins increase insulin release, decrease glucagon release, slow GI emptying and stimulate satiety center.

A nurse at the health care facility is assigned to administer insulin to a patient. Which intervention should the nurse perform before administering each insulin dose?

Inspect the previous injection site for inflammation.

The nurse is discussing diabetes with a group of individuals who are at risk for the for the disease. Which statement by a participant indicates an understanding of the role of insulin in the disease?

Insulin assists glucose molecules to enter the muscle and fat tissues.

Which would be appropriate to include in teaching a client with type 2 diabetes?

It is possible weight weight loss and exercise to discontinue the use of anti diabetic medications.

Rosiglitazone is being considered for the treatment of diabetes in an adult male client. Before the initiation of rosiglitazone therapy, the nurse should review what laboratory work recently drawn?

Liver enzymes. Rosiglitazone is associated with hepatotoxicity.

After teaching a class about the various drugs used to control blood glucose, the instructor determines that the teaching was successful when the class identifies what as biguanide?

Metformin

A 58 year old male client, diagnosed with diabetes at age 14, reports having pain in both feet and hands. What is the pain MOST likely a result of?

Peripheral Neuropathy. Pain in the hands and feet is related to changes in small blood vessels resulting in neuropathy.

A student asks the nursing instructor what insulin has the quickest therapeutic effect once administered. What would be the best response?

Regular (Humulin R). Regular insulin has the quickest onset of 30-60 minutes.

A nurse is preparing to administer insulin intravenously to a client with a blood glucose level over 600. What type of insulin will the nurse most likely give?

Regular Insulin. Rapid onset, can be given via IV.

After teaching a group of students about the various methods for the delivery of insulin, the instructor determines that the teaching was successful when the students identify which method as most commonly used for administration?

Subcutaneous injection.

A patient at a health care facility has been prescribed diazoxide for hypoglycemia due to hyperinsulinism. What adverse reactions to the drug should the nurse monitor for in the patient?

Tachycardia

Which condition must be met in order for glyburide treatment to be effective?

The client must have functioning pancreatic beta cells. Because glyberide stimulates pancreatic beta cells to produce more insulin, it is effective only when beta cells are present.

A patient with type 1 diabetes has come to the clinic for a routine follow up appointment. While assessing the patient's skin, the nurse observes brown spots on his lower legs. What might these spots indicate?

Widespread changes in blood vessels. Diabetes can cause significant vascular problems. Brown spots on lower legs of a diabetic patient are caused by small hemorrhages into the skin.

The nurse is caring for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia?

a client who received 12 units of insulin R 45 mins ago.

The nurse is caring for a client who has been prescribed glyburide. Which factor, if identified in the client history, would cause the nurse to inform the HCP of a contraindication in use?

allergy to sulfonamides.

The nurse is reviewing a prescription for metformin. The nurse should immediately contact the prescribing health care provider to report a contraindication if the prescription is for what client?

an 82 year old diagnosed with diabetes type 2. There is a black box warning in using metformin in persons older than 80 because of the risk factor for lactic acidosis.

What is the best indicator of overall diabetic control?

glycosylated hemoglobin levels

The nurse educator works at a diabetic clinic. When talking to a class of adolescent diabetics, the educator tells the students that the most recognized signs of diabetes are

hyperglycemia and glycosuria

A client's current condition requires rapid reduction of blood sugar levels. Which type of insulin will have the most rapid onset of action?

insulin lispro. Has a 15 min onset.

A client is prescribed sitagliptin. The nurse would expect to administer this medication via what route?

oral

The nurse is educating a newly diagnosed diabetic who must learn to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from what area of injection?

Abdomen.

A client who began treatment for type 2 diabetes 8 months ago is now meeting with a diabetic nurse for a scheduled follow-up. How can the nurse best assess the client's glycemic control since beginning treatment?

Assess the most recent A1c levels.

A female client is a newly diagnosed diabetic. She is a stay at home mother and responsible for meal planning and management of the home. What will the home care nurse teach this client? Select all that apply.

Assist the client in making menus that will meet the needs of both the client and her family. Watch the client draw up and administer her insulin. Reinforce teaching on hypoglycemia.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?

Avoid mixing glargine with other insulin.

After reviewing information about different insulin preparations, a nursing student demonstrates understanding of the information when the student identifies which medication as an example of a long-acting insulin?

Insulin glargine.

A client newly diagnosed with type 1 diabetes asks the nurse why the client cannot just take a pill. The nurse would incorporate what knowledge when responding to this client?

Insulin is needed because the beta cells of the pancreas are no longer functioning.

What is the expected action of sitagliptin on type 2 diabetes?

It slows the rate of inactivation of the incretin hormones. Sitagliptin minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity.

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously?

Regular. Regular insulin has a rapid IV onset.

Which produce their glucose lowering effect by decreasing insulin resistance and increasing insulin sensitivity? (Select all that apply.)

Rosiglitazone (Avandia), Pioglitozone (Actos)

The nurse is caring for a client who is taking insulin. The nurse suspects the client is experiencing hypoglycemia when the client displays what signs?

Weakness, sweating, and decreased mentation. Symptoms of hypoglycemia include shakiness, dizziness or light headedness, sweating, nervousness, or irritability, sudden changes in mood or behavior, weakness, pale skin, and hunger.

A nurse is caring for a client receiving metformin drug therapy to improve glycemic control. What adverse reaction to the drug does the nurse need to monitor the client for?

asthenia-abnormal weakness or lack of energy which is an adverse reaction of this med.